TRATAMENTO ENDODÔNTICO CONVENCIONAL DE UM SEGUNDO MOLAR INFERIOR EM FORMA DE C, UTILIZANDO LIMAS PRO-DESIGN M, ALIADO AO FECHAMENTO DE PERFURAÇÃO COM CIMENTO BIOATIVO: RELATO DE CASO

The pulp tissue is responsible for the vitality of the dental pulp, it is found inside the root canals system, and it can undergo changes, which may lead to the need for an endodontic intervention. These canals may have anatomical variations, which make the process of cleaning, formatting, and three-dimensional filling even more difficult. Among them, there is the so-called “C-shaped canal”, a connection between two or more canals, which creates great difficulty in the instrumentation process and provides a greater propensity for iatrogenic injuries. The aim of this study was to report the diagnosis and treatment of a lower molar #37 with asymptomatic apical periodontitis, which had a C-shaped root canal. Patient, female, 23 years old, attended the Teaching Clinic of the Instituto Nacional de Ensino Superior e Pós-Graduação Padre Gervásio – Inapós, complaining of sensitivity in the left mandibular region. On clinical examination, extensive restoration was observed on tooth 37. On radiographic examination, a periapical lesion could be observed around the apex of the element in question. Necropulpectomy was performed on the same, using pro-design M files, during which there was a lateral perforation, treated with bioactive cement mineral trioxide aggregate (MTA).   El tejido pulpar es el responsable de la vitalidad de la pulpa dentaria, se encuentra dentro del sistema de conductos radiculares y puede sufrir cambios, lo que puede llevar a la necesidad de una intervención endodóntica. Estos canales pueden tener variaciones anatómicas, lo que dificulta aún más el proceso de limpieza, formateo y obturación tridimensional. Entre ellos, se encuentra el denominado “canal en C”, conexión entre dos o más canales, lo que crea una gran dificultad en el proceso de instrumentación y proporciona una mayor propensión a lesiones iatrogénicas. El objetivo de este estudio fue informar el diagnóstico y tratamiento de un molar inferior #37 con periodontitis apical asintomática, que tenía un conducto radicular en forma de C. Paciente, sexo femenino, 23 años, acudió a la Clínica Docente del Instituto Nacional de Ensino Superior e Pós-Graduação Padre Gervásio – Inapós, quejándose de sensibilidad en la región mandibular izquierda. En el examen clínico se observó una extensa restauración en el diente 37. En el examen radiográfico se pudo observar una lesión periapical alrededor del ápice del elemento en cuestión. En el mismo se realizó necropulpectomía, utilizando limas pro-design M, durante la cual se produjo una perforación lateral, tratada con agregado de trióxido mineral de cemento bioactivo (MTA).   O tecido pulpar, responsável pela vitalidade da polpa dentária, é encontrado no interior dos canais radiculares, e pode sofrer alterações que levam à necessidade de uma intervenção endodôntica. Estes canais podem ter variações anatômicas, as quais dificultam ainda mais o processo de limpeza, formatação e preenchimento tridimensional. Dentre as variações, há o denominado “Canal em C”, ligação entre dois ou mais canais, que gera uma grande dificuldade no processo de instrumentação com maior propensão à iatrogenias. O objetivo deste trabalho foi relatar o diagnóstico e tratamento de um molar inferior #37 com uma periodontite apical assintomática, que possuía canal em C. Paciente J.P.R, sexo feminino, 23 anos, compareceu à Clínica escola do Instituto Nacional de Ensino Superior e Pós-Graduação Padre Gervásio – Inapós, com queixa de sensibilidade na região esquerda mandibular. Ao exame clínico observou-se extensa restauração no dente 37. Ao exame radiográfico, pôde-se observar lesão periapical ao redor do ápice do elemento em questão. Realizou-se uma necropulpecnomia no dente, utilizando limas pro-design M, durante a qual houve uma perfuração lateral, tratada através do cimento bioativo agregado trióxido mineral (MTA).O tecido pulpar, responsável pela vitalidade da polpa dentária, é encontrado no interior dos canais radiculares, e que pode sofrer alterações, as quais podem levar à necessidade de uma intervenção endodôntica. Estes canais podem ter variações anatômicas, as quais dificultam ainda mais o processo de limpeza, formatação e preenchimento tridimensional do mesmo. Dentre elas, há o denominado “Canal em C”, ligação entre dois ou mais canais, que gera uma grande dificuldade no processo de instrumentação e proporciona maior propensão à iatrogenias. O objetivo deste trabalho foi relatar o diagnóstico e tratamento de um molar inferior #37 com uma periodontite apical assintomática, que possuia canal em C. Paciente, sexo feminino, 23 anos, compareceu à Clínica escola do Instituto Nacional de Ensino Superior e Pós-Graduação Padre Gervásio – Inapós, com queixa de sensibilidade na região esquerda mandibular. Ao exame clínico observou-se extensa restauração no dente 37. Ao exame radiográfico, pôde-se observar lesão periapical ao redor do ápice do elemento em questão. Realizou-se uma necropulpecnomia no mesmo, utilizando limas pro-design M, durante a qual houve uma perfuração lateral, tratada através do cimento bioativo agregado trióxido mineral (MTA). 

AVALIAÇÃO DO POTENCIAL HIDROGÊNIO (PH) DO HIPOCLORITO DE SÓDIO EM TRÊS DIFERENTES MOMENTOS ANTES DO SEU VENCIMENTO

O hipoclorito de sódio (NaOCl) é o irrigante mais utilizado no tratamento endodôntico, tendo sido introduzido na endodontia na última metade do século XVIII. O objetivo deste estudo foi avaliar a estabilidade do pH do hipoclorito de sódio (de diferentes concentrações) e solução salina em três momentos diferentes. O pH dos irrigantes foi medido em triplicata usando um medidor de pH Mettler Toledo SevenEasy S20 (Mettler-Toledo AG. Analytical Instruments. Schwerzenbach, Suíça) em três momentos: S1: ao desembalar o frasco da solução; S2: um mês depois; e S3: quatro meses depois. Os dados foram submetidos a testes de normalidade. Em seguida, foram analisados ​​pelos testes One-way Anova e Tukey pelo GraphPad Prism 6 (La Jolla, CA, EUA) com nível de significância de 5%. Verificou-se que houve diferença estatisticamente significativa entre os grupos Hipoclorito de Sódio 1% e 2,5% em comparação com os grupos soro fisiológico e água destilada em S1, S2 e S3. Além disso, constatou-se que o hipoclorito de sódio 1% perde seu pH alcalino desde o primeiro mês. No entanto, o hipoclorito de sódio 2,5% foi mais estável após 4 meses. Concluiu-se que o tempo de armazenamento tem efeito na estabilidade do pH do hipoclorito de sódio 1%.El hipoclorito de sodio (NaOCl) es el irrigante más utilizado en el tratamiento de endodoncia, habiéndose introducido en la endodoncia en la última mitad del siglo XVIII. El objetivo de este estudio fue evaluar la estabilidad del pH del hipoclorito de sodio (de diferentes concentraciones) y solución salina en tres tiempos diferentes. El pH de los irrigantes se midió por triplicado utilizando un pHmetro Mettler Toledo SevenEasy S20 (Mettler-Toledo AG. Analytical Instruments. Schwerzenbach, Suiza) en tres momentos: S1: al desempacar el frasco de solución; S2: un mes después; y S3: cuatro meses después. Los datos fueron sometidos a pruebas de normalidad. Luego, se analizaron mediante pruebas One-way Anova y Tukey por GraphPad Prism 6 (La Jolla, CA, EE. UU.) con un nivel de significancia del 5%. Se encontró que hubo una diferencia estadísticamente significativa entre los grupos de Hipoclorito de Sodio 1% y 2,5% en comparación con los grupos de solución salina y agua destilada en S1, S2 y S3. Además, se encontró que el hipoclorito de sodio al 1% pierde su pH alcalino desde el primer mes. Sin embargo, el hipoclorito de sodio al 2,5% fue más estable después de 4 meses. Se concluyó que el tiempo de almacenamiento tiene efecto en la estabilidad del pH del hipoclorito de sodio al 1%.Sodium hypochlorite (NaOCl) is the most common used irrigant for root canal treatment, it was introduced into endodontics in the last half of XVIII century. the aim of this study was to evaluate the pH stability of sodium hypochlorite (of different concentrations) and saline solution at three different moments. The pH of the irrigants was measured in triplicate using a pH meter Mettler Toledo SevenEasy S20 (Mettler-Toledo AG. Analytical Instruments. Schwerzenbach, Switzerland) at three moments: S1: upon unpacking the solution bottle; S2: one month later; and S3: four months later. Data were submitted to normality tests. Then were analyzed by One-way Anova and Tukey tests by GraphPad Prism 6 (La Jolla, CA, USA) with a significance level of 5%.   It was found that there was a statistically significant difference among the Sodium hypochlorite 1% and 2.5% in comparison with the saline solution and distilled water groups in S1, S2 and S3. Besides, it was found that sodium hypochlorite 1% loses its alkaline pH since the first month. However, sodium hypochlorite 2.5% was more stable after 4 months. It was concluded that The storage time has an effect on 1% sodium hypochlorite pH stability.O hipoclorito de sódio (NaOCl) é o irrigante mais utilizado no tratamento endodôntico, tendo sido introduzido na endodontia na última metade do século XVIII. O objetivo deste estudo foi avaliar a estabilidade do pH do hipoclorito de sódio (de diferentes concentrações) e solução salina em três momentos diferentes. O pH dos irrigantes foi medido em triplicata usando um medidor de pH Mettler Toledo SevenEasy S20 (Mettler-Toledo AG. Analytical Instruments. Schwerzenbach, Suíça) em três momentos: S1: ao desembalar o frasco da solução; S2: um mês depois; e S3: quatro meses depois. Os dados foram submetidos a testes de normalidade. Em seguida, foram analisados ​​pelos testes One-way Anova e Tukey pelo GraphPad Prism 6 (La Jolla, CA, EUA) com nível de significância de 5%. Verificou-se que houve diferença estatisticamente significativa entre os grupos Hipoclorito de Sódio 1% e 2,5% em comparação com os grupos soro fisiológico e água destilada em S1, S2 e S3. Além disso, constatou-se que o hipoclorito de sódio 1% perde seu pH alcalino desde o primeiro mês. No entanto, o hipoclorito de sódio 2,5% foi mais estável após 4 meses. Concluiu-se que o tempo de armazenamento tem efeito na estabilidade do pH do hipoclorito de sódio 1%

In vitro Evaluation of the Antimicrobial Effect of N-acetylcysteine and Photodynamic Therapy on Root Canals Infected with Enterococcus faecalis

Introduction: This study aimed to evaluate the effectiveness of N-acetylcysteine (NAC), photodynamic therapy (PDT) and NAC with supplemental PDT in optimizing the removal of bacteria from infected dentinal tubules of root canals infected with Enterococcus (E.) faecalis biofilm. Methods and Materials: Eighty human teeth were randomly divided into 5 groups (n=16) according to the intracanal medication used: saline solution (control); calcium hydroxide (CH); NAC; PDT; NAC+PDT. Ten samples from each group were prepared for microbiological culture analysis (CFU/mL) and were inoculated with E. faecalis suspension for 21 days for biofilm development; the other six samples from each group were prepared for scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) and submitted to a 5-days contamination protocol including eight centrifugation cycles on every other day for dentinal tubules infection. For antimicrobial activity analysis by microbiological culture, the root canals were contaminated with E. faecalis biofilm, instrumented and then medicated according to the experimental groups. Three samples were collected from the root canals: after 21-days of contamination, immediately after the instrumentation and 14-days after the medication according to the experimental groups. The morphology of E. faecalis biofilm on the root canal walls and bacterial cells viability were assessed by means of SEM and CLSM, respectively. One-way ANOVA and Repeated Measures ANOVA tests were used to analyze the obtained data statistically. Results: CFU/mL analysis showed that CH, NAC and NAC+PDT promoted greater antibacterial activity with statistically significant difference compared to saline solution and PDT (P<0.0001). However, saline solution and PDT were statistically similar. Illustrative images by SEM confirmed partially the CFU/mL results. CLSM showed that all groups were effective eliminating E. faecalis except for the saline solution group. Conclusions: Based on this in vitro study NAC was bactericidal against E. faecalis biofilms regardless PDT stimulation, presenting similar antimicrobial activity to CH

OS (DES)ACERTOS DO LEGISLADOR NA “POSITIVAÇÃO” DAS TEORIAS DE ROBERT ALEXY NO DIREITO PROCESSUAL CIVIL BRASILEIRO

This article deals with the application of Robert Alexy’s legal theories in Paragraphs 1 and 2 of article 489 of the Brazilian Civil Procedure Code. Therefore, the study is structured in two parts. In the first, it introduces the theory of juridical argumentation, briefly, and analyzes the provisions contained in Paragraph 1 of article 489 of the Civil Procedure Code based on the mentioned theory, observing the harmony between the legal text and Alexy’s doctrinal formulations. In the second part, the study presents his theory of fundamental rights, with emphasis on the distinction between rules and principles, maximum proportionality and deliberation technique, and examines Paragraph 2 of Article 489 of the Civil Procedure Code, verifying the total dissonance between the legal text and Alexy’s theoretical basis. In conclusion, at the end, the paper indicates the right and wrong decisions of the Brazilian legislators, pointing out their consequences for the Brazilian Law.El presente artículo busca identificar la presencia de elementos de la teoría jurídica de Robert Alexy en los §§ 1 y 2 del artículo 489 del Código de Procedimiento Civil. Para ello, el estudio se estructura en dos partes. En la primera,  después de introducir la teoría de la argumentación jurídica, analiza los dispositivos contenidos en el §1º del artículo 489 del Código de Procedimiento Civil a la luz de dicha teoría, observándose la armonía entre el texto legal y algunas de las formulaciones doctrinales de Alexy. En la segunda parte, presenta la teoría de los derechos fundamentales, con énfasis en la distinción entre reglas y principios, en la máxima proporcionalidad y en la técnica de la ponderación, y examina el §2º del artículo 489 del Código de Procedimineto Civil, verificando la total disonancia entre el texto y las bases teóricas de Alexy. En la conclusión, al final, se indican los (des)aciertos del legislador, apuntando sus consecuencias al derecho brasileño.O presente artigo busca identificar a presença de elementos da teoria jurídica de Robert Alexy nos §§ 1º e 2º do artigo 489 do Código de Processo Civil. Para tanto, o estudo estrutura-se em duas partes. Na primeira, após introduzir a teoria da argumentação jurídica, analisa os dispositivos contidos no §1º do artigo 489 do Código de Processo Civil à luz da referida teoria, observando-se a harmonia entre o texto legal e alguma das formulações doutrinárias de Alexy. Na segunda, apresenta a teoria dos direitos fundamentais, com ênfase na distinção entre regras e princípios, na máxima da proporcionalidade e na técnica da ponderação, e examina o §2º do artigo 489 do Código de Processo Civil, verificando a total dissonância entre o texto legal e as bases teóricas de Alexy. Na conclusão, ao final, indicam-se os (des)acertos do legislador, apontando suas consequências para o direito brasileiro

Bond strength of cemented fiber posts to teeth with simulated internal root resorption

Teeth with internal root resorption (IRR) have guarded prognosis, considering that IRR defect could influence on the post bond strength. The aim of this study was to evaluate the bond strength and the bond interface between different glass fiber-reinforced posts (FRP) after cementation in teeth with simulated internal root resorption (IRR). Forty-five (45) human premolar roots with simulated IRR were embedded in acrylic resin blocks and cross-sectioned into two segments, enabling them to be re-approximated by screws. Intracanal medication was inserted for 15-days, removed by passive ultrasonic irrigation (PUI) and examined by stereomicroscopy. The push-out bond strength of two fiber reinforced composite posts (Rebilda Post - RP) and Rebilda Post GT ? GT, (VOCO) were evaluated at the cervical and IRR regions (n = 20). And, the bonded interface between resin cement and root dentine was analysed by scanning electron microscopy (SEM). 62.5% of IRR were not completely cleaned by PUI. Bond strength values at the cervical region (9.8 and 14.6 MPa) were higher than the IRR region (6.3 and 4.2 MPa). Micrographies showed bubbles in the cement and spaces in the bonded interface. RP post showed better bond strength at the cervical region while GT had better bond strength at the IRR region

Replication Data for: Adhesive systems effect over bond strength of resin-infiltrated and de/remineralized enamel

Table. 1 Raw data of bond strength values (MPa) in all experimental groups with self-etching adhesive system (One-step self-etching)

Correlation between Tooth Position Parameters and Apical Fenestration: A Cone-Beam Computed Tomography Study

This study aimed to assess the relationship between apical fenestration—a defect in the alveolar bone involving the root apex—and tooth position in all tooth groups, excluding the third molars, utilizing cone-beam computed tomography (CBCT) images. A total of 800 CBCT scans (400 maxillary and 400 mandibular) from patients undergoing various treatments were examined by a single professional (radiologist and endodontist). Statistical analyses, including the chi-square test or Fisher’s exact test, were conducted using R software 2.7.3 (R Foundation, Vienna, Austria). Results indicated a significant association (p ≤ 0.05) between apical fenestration and tooth position. In the upper teeth, apical fenestrations were notably present in the mesio-buccal (17.17%) and disto-buccal (11.07%) roots of the first molars. Conversely, apical fenestrations in the lower teeth were relatively less frequent. The study revealed a negative correlation between apical fenestration and mesial inclination, rotation, and extrusion in the upper teeth. However, a positive correlation was observed between apical fenestration and lingual inclination in the upper teeth. In conclusion, this study illuminates the distribution of apical fenestration and its correlation with tooth positions, offering insights into factors influencing this defect in dental anatomy. The findings enhance our understanding of nuanced relationships between tooth position and apical fenestration in the upper and lower dental arches

Effect of Nd:YAG Laser with/without Graphite Coating on Bonding of Lithium Disilicate Glass-Ceramic to Human Dentin

This study evaluated the effect of different surface treatments on the tensile bond strength between lithium disilicate glass-ceramics, resin cement, and dentin. Fifty truncated cone-shape glass-ceramics were divided into five groups (n = 10): G1, control: 10% hydrofluoric acid (HF); G2, Nd:YAG laser + silane; G3, Sil + Nd:YAG laser; G4, graphite + Nd:YAG laser + Sil; and G5, graphite + Sil + Nd:YAG laser. Fifty human third-molars were cut to cylindrical shape and polished to standardize the bonding surfaces. The glass-ceramic specimens were bonded to dentin with a dual-cured resin cement and stored in distilled water for 24 h at 37ºC. Tensile testing was performed on a universal testing machine (10 Kgf load cell at 1 mm/min) until failure. The bond strength values (mean ± SD) in MPa were G1 (9.4 ± 2.3), G2 (9.7 ± 2.0), G3 (6.7 ± 1.9), G4 (4.6 ± 1.1), and G5 (1.2 ± 0.3). Nd:YAG laser and HF improve the bond strength between lithium disilicate glass-ceramics, resin cement, and dentin. The application of a graphite layer prior to Nd:YAG laser irradiation negatively affects this bonding and presented inferior results

Effect of Remineralization Pretreatments on Human Dentin Permeability and Bond Strength

This study aimed to evaluate Nd:YAG laser, calcium phosphate, and adhesive system effect as different pretreatments in different protocols on dentin permeability (DP) and bond strength (BS). Fifty human dentin discs were used (4 mm in diameter and 1,5 mm in height). Specimens were divided into five groups (n = 10): (A): adhesive system (control); (AL): adhesive system + Nd:YAG laser; (LAL): Nd:YAG laser + adhesive system + Nd:YAG laser; (PAL): calcium phosphate-based dentin desensitizer TeethMate + adhesive system + Nd:YAG laser; and group (PLAL): Nd:YAG laser + calcium phosphate-based dentin desensitizer + adhesive system + Nd:YAG laser. All materials were used according to the manufacturers’ instructions. The specimens were submitted to artificial aging (5,000 thermal cycles and 12 × 104 mechanical cycles) then a bond test was performed. DP was measured using the split chamber model. Data were submitted to one-way analysis of variance (ANOVA), paired t-test, RM ANOVA, and Tukey test (p<0.05). All treatments were effective in DP reduction. For BS, the groups PAL and PLAL had improved BS with a statistically significant difference of the control group (A). Nd:Yag laser irradiation and calcium phosphate-based desensitizing agents significantly reduced DP, and the association between them could improve the BS on resin–human dentin interface

Assessing the cyclic fatigue resistance and sterilization effects on replica-like endodontic instruments compared to Reciproc Blue

Abstract This study aimed to evaluate the effect of the number of uses and autoclave sterilization on the cyclic fatigue resistance of four replica-like instruments RC Blue; Only One File Blue; Recip One Blue; and Micro Blue compared to the original system Reciproc Blue (VDW, Munich, Germany). The instruments were analyzed by scanning electron microscope (SEM) before being used in root canal instrumentation (baseline). Fifty molars were instrumented by ten instruments (n=10). After sterilization in an autoclave, the  instruments were analyzed by SEM. This procedure was repeated twice more using different molars, totaling 3 rounds of instrumentation, sterilization and SEM analysis. Then, ten different instruments from each brand were tested for cyclic fatigue resistance. Number of uses data were analyzed using Chi-squared analysis, and cyclic fatigue data were analyzed by one-way Anova followed by Tukey’s test as the data had normal distribution. The fracture times for all systems had no significant difference, but Micro Blue had significantly lower values than the other systems (p < 0.05). The SEM analysis showed distortions in the instruments after the 3rd use. Therefore, all tested instruments except of Micro Blue have similar resistance to cyclic fatigue, and all are reliable for use in up to 2-cases